Prosthetics and Orthotics International最新文献

Objectives: To achieve functional and comfortable prostheses, great attention must be paid to socket design, as it represents a critical interface between the residual limb and the prosthetic limb. This study aimed to evaluate the outcomes of unilateral transtibial amputees utilizing modified socket casting/molding technique in comparison to total surface bearing (TSB) socket.

Methods: Eight individuals with unilateral transtibial amputation participated in this cross-over design trial. Each participant used both the TSB and modified socket casting/molding designs. Four weeks after the utilization of each socket, the assessment was conducted on socket fit satisfaction (measured through the Comprehensive Lower Limb Amputee Socket Survey), socket rotation (evaluated using a standard meter), socket/liner interface pressure (monitored with 10 force-sensitive resistors), and the amputees' decision regarding the retention of one of the sockets after the trials (gauged via a numerical rating scale).

Results: The amputees experienced greater stability ( P = 0.02) and improved lateral rotational control ( P = 0.01) during prosthetic gait when using the modified socket, compared with the TSB socket. Local pressure on the anterodistal tibia and the head of the fibula was not statistically significant ( P > 0.05) between 2 socket types. The decision of participants to retain the modified socket was significantly higher than that for the TSB socket after the trial period ( P = 0.03).

Conclusion: The modified socket design may offer advantages by providing improved rotational control during walking and reducing local pressure on the anterodistal tibia and fibula head. In addition, it maintains the total surface contact concept.

Background: Offloading knee braces can reduce pain and improve mobility in patients with knee osteoarthritis.

Objectives: This study aimed to determine the effectiveness of the new UniReliever knee brace and to compare it to the widely used Unloader One X device.

Methods: In this open-label, three-arm parallel-group randomized trial, 60 patients with medial knee osteoarthritis (Kellgren-Lawrence grade II‒IV), 34 male and 26 female with a mean age of 69.62 ± 9.57 years and mean body mass index of 26.86 ± 3.18 kg/m2, were recruited from an orthopedic center. The patients were randomly allocated to receive a UniReliever device, an Unloader One X device, or no knee brace (control). The primary outcome was the change in the pain-free walking distance from baseline to 6 weeks. Other measures included the Lequesne index, pain on exertion, range of motion, and analgesic use.

Results: The mean pain-free walking distance more than doubled for the UniReliever group (from 2.0 ± 1.4 km to 4.6 ± 3.4 km) and the Unloader One X group (from 2.6 ± 2.3 to 5.6 ± 3.7 km), but not for the controls (from 1.3 ± 1.2 to 1.4 ± 1.3 km; comparisons with controls: p < 0.0001). The Lequesne index and pain on exertion also improved for the 2 knee brace groups (p < 0.05 for all comparisons with controls; p > 0.05 for comparisons between the knee brace groups), and the use of analgesics fell (UniReliever: 4/7 patients; Unloader One X: 8/11 patients; whereas controls: 1/9 patients). There were no serious adverse events.

Conclusions: The UniReliever offloading knee brace can improve mobility and reduce pain in patients with medial knee osteoarthritis. The benefits are similar compared with the Unloader One X.

Trial registration: Clinical Trials NCT05905809.

Background: Spinal orthoses can be used to limit active range of motion in different directions and to support trunk extension; however, their effect on movement and muscle activity remains uncertain.

Objective: This study explored the effects of two semi-rigid spinal orthoses on trunk kinematics and muscle activity compared to no brace (NB).

Study design: A pre-clinical, feasibility study.

Methods: Markerless motion capture and surface electromyography was collected from 20 healthy participants each performing 5 repetitions of a sit-to-stand-to-sit task under three conditions: NB, Brace A (Medi Spinomed®, Bayreuth, Germany), and Brace B (DonJoy® Osteostrap, Enovis, UK). Repeated measures analysis of variance was used to evaluate trunk kinematics and muscle activity between conditions.

Results: During sit-to-stand, average muscle activity of the dominant latissimus dorsi was significantly reduced in Brace A compared to NB (MD = 0.13, p = 0.019), but there were no differences between Brace A and Brace B (MD = -0.08, p = 0.097). During both standing and sitting, participants were significantly more flexed forward in Brace A compared to NB (MD = 1.65-2.23, p < 0.015) and Brace B (MD = 1.46-1.55, p = 0.040). During stand-to-sit, peak extension angular velocity significantly increased in Brace A and Brace B compared to NB (MD = 5.74, p = 0.011, MD = 6.68, p = 0.046, respectively). Central tendencies for perceived comfort were "comfortable" for both braces, and perceived ease of task performance was "very easy" for Brace A and "easy" for Brace B, with brace preference split equally.

Conclusions: Active range of motion was not limited using either brace; however, these did assist movement into extension, which may offer a clinical benefit, with small changes also seen in latissimus dorsi muscle activity. Further work including clinical populations is warranted using intervention periods that reflects clinical practice.

Background: The Orthotics and Prosthetics Users' Survey is a validated tool designed to assess patient satisfaction, functional ability, and overall experience with orthotic and prosthetic devices. By providing normative values, it enables healthcare providers to compare individual scores against population averages.Objective: This study establishes normative values and explores longitudinal changes in lower extremity functional status (LEFS) and health-related quality of life (HRQoL) among lower limb prosthetic users.Study Design: A secondary analysis was conducted on data collected over four years from 186 participants who completed at least three out of five surveys during a 12-month follow up period.

Methods: Data were gathered from 13 prosthetic clinics across the United States. To evaluate longitudinal changes in LEFS and HRQoL, separate generalized linear mixed models were applied, adjusting for age, gender, diabetes, presence of comorbidities, etiology, use of assistive devices, level of amputation, patient type, and employment.

Results: LEFS scores remained stable over time. HRQoL had time interactions with patient type and level of amputation. Employment had a positive influence on both outcomes.

Conclusions: Rehabilitation strategies for lower limb prosthetic users should emphasize targeted, individualized approaches that address health-related barriers, aim to promote independence from assistive devices, and enhance social and occupational engagement.

Background: An aging society and the rise in peripheral arterial disease and diabetes mellitus generate a high prevalence of lower limb loss. Medical advancements extend lifespans and make effective rehabilitation necessary to preserve long-time mobility and independence. This study aims to explore the experiences of long-term prosthesis users, investigating the factors influencing their prosthetic mobility and the resulting impact on independence.

Methods: Experienced prosthesis users were recruited from rehabilitation clinics and orthopedic companies and participated in focus group interviews. These interviews were transcribed verbatim and analyzed by systematic text condensation to identify themes.

Results: Two main themes were identified: "The Goal of Prosthetic Mobility is Independence" and "Lack of Knowledge Threatens Mobility." Prosthesis users highly value independence, with prostheses being crucial for enabling freedom without reliance on others. However, this independence is fragile, as even minor issues concerning prosthetic components or impairments can affect mobility and independence. Health care professionals were often described as lacking in specialized knowledge in the complexities of long-time prosthetic care, which limits their support for prosthesis users. At the same time, peer expertise is highly valued for practical advice. Integrating peer expertise into education and rehabilitation programs appears essential for improving care.

Conclusions: The findings suggest a knowledge gap among health professionals that may threaten the mobility and independence of experienced prosthesis users. Although users develop their practical competence and skills by prosthetic use, health professionals make slight use of the opportunities to enhance their competence by listening to and collaborating with prosthesis users. By recognizing patients as experts in their bodies, their insights can complement and strengthen professional competence and lead to more effective rehabilitation.

Background: In South Africa, persons with lower limb amputations face significant barriers to accessing prosthetic rehabilitation due to geographic, financial, and systemic constraints. mHealth applications offer a promising alternative, but evidence-based guidelines tailored to the study population are limited.

Objective: To identify evidence-based rehabilitation interventions that can inform a rehabilitation application for transtibial prosthetic users in South Africa.

Study design: A qualitative descriptive design was applied in the study.

Methods: Telephonic semistructured interviews were conducted with prosthetic users (n = 8), prosthetists (n = 8), and physiotherapists (n = 10). Content data analysis was performed, and data were triangulated to identify essential rehabilitation interventions that can be included in an application.

Results: Findings recommended exercise interventions focusing on balance, weight-bearing, joint mobility, muscle strength, and gait retraining. Additional application features should include a rehabilitation roadmap, patient education, and access to peer support networks.

Conclusion: An mHealth application incorporating evidence-based exercises and user-informed features can help overcome access barriers to prosthetic rehabilitation in South Africa. Such an application has the potential to enhance functional outcomes, promote self-management, and support healthcare providers in delivering consistent, quality rehabilitation.

Background: Efficacy of custom-made foot orthoses largely depends on geometric characterization and outcomes can be suboptimal due to insufficient quantitative insights thereof. Addressing this is crucial for understanding geometric characteristics in dosage-response modeling.

Objective: This study evaluates the reliability of digitizing traditional and advanced geometric foot features, using a handheld 3-dimensional (3D) scanning system.

Methods: Two examiners used a handheld 3D scanner to capture the foot shape of 30 healthy participants in a non-weight-bearing condition. Intra-tester, test-retest, and inter-tester reliabilities of several linear anthropometric and geometric variables were evaluated. Subsequently, the consistency of capturing the geometry of the plantar foot surface was assessed by quantifying 2 anteroposterior and 2 mediolateral curvilinear plantar surface metrics.

Results: Intraclass correlation coefficients for the linear geometric and anthropometric variables' intra- and inter-tester reliability ranged from 0.84 to 1.00. The standard error of measurement for the Z-coordinate of the proximal medial arch point and the forefoot-rearfoot angle was substantially higher compared with the standard error of measurements observed in the other metrics. A pairwise comparison of the 4 curvilinear metrics showed no statistically significant difference on intra-tester and test-retest levels for both examiners. Inter-tester analysis identified significant (p < 0.05) differences in specific segments of the anteroposterior and mediolateral curvilinear metrics, particularly near the distal and medial ends.

Conclusions: These results demonstrated that the digitization of linear anthropometric and geometric measurements of the human foot, obtained using a handheld 3D scanning system in a non-weight-bearing condition, exhibit good to excellent reliability. Additionally, the curvilinear metrics, related to the plantar surface curvature, showed high consistency, supporting its usage to quantify plantar geometry and provide insights into the role of geometric characteristics in dosage-response modeling in custom-made foot orthoses practice.

Background: Participation in physical activity (PA) for health by people with transtibial amputation (PTTA) may moderate comorbidities experienced by this population. It is more likely that interventions which aim to increase participation by PTTA in PA for health will increase participation if the type of PA used is tailored to the preferences of the PTTA.

Objective: This study aimed to identify the types of PA performed by PTTA, the types of PA PTTA who performed no physical activities would like to adopt, and if these outcomes were influenced by the cause of amputation.

Methods: The cross-sectional survey was accessible through an online survey tool and in paper format. It was distributed primarily at sports events and relevant locations, which support people with limb differences. A total of 115 PTTA adults (both active and those who did not perform any physical activities) completed the survey, consisting of 65 people with amputation due to traumatic causes and 50 people with amputation due to nontraumatic causes.

Results: From all PTTA respondents, the most popular current activities were walking (N = 42), going to the gym (N = 39), swimming (N = 35), and cycling (N = 32). For PTTA who did not perform any physical activity, the most popular PA they would like to participate in were walking (N = 10), going to the gym (N = 8), swimming (N = 7), and cycling (N = 6). While there are differences in the hierarchy of popularity of different types of PA depending on the cause of amputation, these results indicate some consistencies.

Conclusions: Walking, going to the gym, swimming, and cycling appear throughout the results, indicating a potential to encourage PTTA participation in PA for health through these activities.

Background: Prosthetic socket is a key component of the prosthesis for clinical application; its performance directly affects the adaptation of the residual limb to the prosthetic socket. There are long-term and short-term volume fluctuation of the residual limb. The volume fluctuation of the residual limb will lead to the pressure mismatch at the interface of the residual limb and the prosthetic socket, which will cause a series of skin and fit problems. The volume fluctuation of the residual limb is considered a key factor for the successful application of the prosthetic socket; its solution is imminent. The purpose of this paper is to design a prosthetic socket with a constant force unit to solve the problem of volume fluctuation of the residual limb.

Methods: Constant force extrusion for the residual limb is proposed to solve the problem in this paper. A constant force unit is designed based on the superelasticity of shape memory alloy, and a semi-open prosthetic socket embedded in the constant force unit is designed. The constant force property of prosthetic socket is optimized and verified by finite element analysis.

Results: The constant force unit obtains a maximum constant force region of 9.36 mm at 13 mm applied displacement, and the minimum stress amplitude is 0.0264%.

Conclusions: The semi-open prosthetic socket may achieve constant pressure at the interface between the residual limb and prosthetic socket within a certain range of the residual limb volume change, and it has a lightweight, good heat dissipation, size adjustability, and constant interface pressure.

Background: Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown.

Objectives: The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research.

Study design: Mixed methods.

Methods: The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking.

Results: Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students , program evaluation , and clinical education and internship . Protected time and funding , faculty development , and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice , program resources , and program evaluation .

Conclusions: Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.